Content and process: using continuous quality improvement to teach and evaluate learning outcomes in quality improvement residency education.

Psychiatry has not prioritised quality improvement and patient safety (QIPS) to the same degree as other medical specialties. Professional capacity building in QIPS through the education of residents is essential to improving the quality and safety of mental healthcare delivery. The University of Toronto postgraduate psychiatry program is the largest psychiatry training program in North America. Training in QIPS was introduced in 2006. In 2019, a curricular review found that few trainees acquired competence in QIPS. Curricular change was undertaken using Kern's Six-Step Approach to curricular design. We used a continuous quality improvement framework to inform the evaluation with data collection using an online educational application. We aimed to improve competence in QIPS as demonstrated by assessment of the quality of individual quality improvement projects (IQIP) on an 11-item rubric. We used a family of quality improvement measures to iteratively improve the curriculum over 3 years. We restructured the QIPS curriculum into four case-based seminars for third year psychiatry residents. The curriculum included: clear learning objectives, multimodal instructional methods, and an IQIP. The mean score on preintervention project evaluations was 5.3/11 (49% (18)), which increased to 9.2/11 (84% (11.5)) with the revised curriculum (t=8.80, two tail, p<0.001; Cohen's ds 2.63). In the first two cohorts of residents to complete the IQIPs, 67/72 (93%) completed at least one Plan-Do-Study-Act cycle, compared with 11/23 (48%) in the 2 years before the new curriculum. To ensure our trainees were attaining the educational goal of competence in QIPS, we introduced a revised QIPS curriculum and embedded an evaluation rooted in improvement science. This study adds to the limited literature which uses continuous quality improvement to enhance QIPS education, which is particularly needed in mental health.

Burra T ，Peck JR ，Waddell AE 《-》

Development, implementation and evaluation of a novel quality improvement and patient safety curriculum in an emergency medicine residency training program.

Proficiency in Quality Improvement and Patient Safety (QIPS) methodologies has been identified as a standard of residency training. However, there is no consensus on how to achieve these competencies. We used Kern's model of curricular development to create a QIPS curriculum for the local Emergency Medicine (EM) residency training program. The curriculum was designed following best practice recommendations for QIPS education and took the form of a 10-h educational experience including two in-person live sessions. The curriculum was delivered to a mix of local transition to practice residents and faculty members. Participants reported favorable outcomes and objectively demonstrated QIPS knowledge acquisition. This curriculum serves as a model that could be adapted by other residency training programs seeking to implement their own QIPS curricula.

Trivedi SV ，Peterson K ，Paterson Q ，Woods R ... -  《-》

Creating a Framework to Integrate Residency Program and Medical Center Approaches to Quality Improvement and Patient Safety Training.

Quality improvement and patient safety (QIPS) are core components of graduate medical education (GME). Training programs and affiliated medical centers must partner to create an environment in which trainees can learn while meaningfully contributing to QIPS efforts, to further the shared goal of improving patient care. Numerous challenges have been identified in the literature, including lack of resources, lack of faculty expertise, and siloed QIPS programs. In this article, the authors describe a framework for integrated QIPS training for residents in the University of Washington Internal Medicine Residency Program, beginning in 2014 with the creation of a dedicated QIPS chief resident position and assistant program director for health systems position, the building of a formal curriculum, and integration with medical center QIPS efforts. The postgraduate year (PGY) 1 curriculum focused on the culture of patient safety and entering traditional patient safety event (PSE) reports. The PGY-2 curriculum highlighted QIPS methodology and how to conduct mentored PSE reviews of cases that were of educational value to trainees and a clinical priority to the medical center. Additional PGY-2/PGY-3 training focused on the active report, presentation, and evaluation of cases during morbidity and mortality conferences while on clinical services, as well as how to lead longitudinal QIPS work. Select residents led mentored QI projects as part of an additional elective. The hallmark feature of this framework was the depth of integration with medical center priorities, which maximized educational and operational value. Evaluation of the program demonstrated improved attitudes, knowledge, and behavior changes in trainees, and significant contributions to medical center QIPS work. This specialty-agnostic framework allowed for training program and medical center integration, as well as horizontal integration across GME specialties, and can be a model for other institutions.

Chen A ，Wolpaw BJ ，Vande Vusse LK ，Wu C ，Meo N ，Staub MB ，Hicks KG ，Carr SA ，Schleyer AM ，Harrington RD ，Klein JW ... -  《-》

QIPS CURE: Implementing a Quality Improvement and Patient Safety Curriculum and Resident Experience.

Resident participation in quality improvement and patient safety (QIPS) programs is an essential training experience and Accreditation Council for Graduate Medical Education requirement. However, the most effective approach to achieve this is unclear. We developed an experiential Quality Improvement and Patient Safety Curriculum and Resident Experience (QIPS CURE) program, which provides internal medicine (IM) residents with foundational QIPS knowledge, and evaluated its effectiveness. After reviewing IM residency QIPS curricula and obtaining input from institutional stakeholders in 2013-2014, we launched a longitudinal QIPS curriculum for all 66 postgraduate year 1-3 IM residents in July 2014. The QIPS CURE included 2 major elements: didactics, delivered through a variety of sources, including online modules and workshops, and hands-on projects. We delivered this curriculum annually from 2014 to 2018. We used project completion and an attitude survey of participants to evaluate it. Six projects were completed in 2014-2015, and 10 projects completed yearly for the next 3 academic years. Residents presented all projects at regional meetings. Surveyed residents reported improvement in understanding (M = 5.71, SD = 1.07 pre- to M = 6.38, SD = 0.49 post-curriculum, P = .013) and competence (M = 3.31, SD = 1.18 pre- to M = 6.08, SD = 0.77, post-curriculum, P < .001) when comparing graduates of the curriculum with incoming interns. Qualitative analysis revealed perceived acquisition of skills needed to carry out successful QIPS projects. This QIPS program was sustainable over 4 years and generally well-received by residents, with many projects completed each year.

Mustafa RA ，Gillenwater K ，Miller SK ，Aly A ，Pamulapati H ，Sifers TM ，Naji D ，Drees B ，Wooldridge D ... -  《-》

Expanding Training in Quality Improvement and Patient Safety Through a Multispecialty Graduate Medical Education Curriculum Designed for Fellows.

Although the Accreditation Council for Graduate Medical Education requires quality improvement and patient safety (QIPS) training for fellow-level trainees, this experience is often insufficient due to lack of faculty time and expertise within fellowship training programs. We developed a centralized GME curriculum targeted to an integrated, multispecialty audience of fellow-level trainees with the goal of promoting leadership and scholarship in QIPS. The University of Colorado implemented the Fellows' Quality and Safety Academy, a three-seminar curriculum in patient safety and health systems improvement. As most participants had prior training in QIPS during medical school or residency, educational strategies emphasized application of QIPS concepts through focused didactic content review paired with small-group case-based exercises and coaching of experiential project work to promote content mastery as well as practice of leadership and scholarship strategies. Since the curriculum's inception in 2017, there have been 106 participants in the Foundations in Patient Safety seminar, 49 participants in the Adverse Events Into Quality Improvement seminar, and 48 participants in the Quality in Academics seminar. These participants represented 44 separate fellowship disciplines from both adult and pediatric subspecialties. Learners reported improved attitudes and confidence and demonstrated objective knowledge acquisition across QIPS content domains. Our pedagogical approach of centralizing QIPS training and harnessing faculty expertise to teach fellow-level trainees across specialties through interdisciplinary collaboration and interactive project-based work is an effective strategy to promote development of QIPS competencies during fellowship training.

Neumeier A ，Levy AE ，Gottenborg E ，Anstett T ，Pierce RG ，Tad-Y D ... -  《-》